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The Rationale and Management of Hyperglycemia for In-Patients with Cardiovascular Disease: Time for Change

Division of Metabolism, Endocrinology, and Nutrition, University of Washington School of Medicine (D.L.T., I.B.H.), and University of Washington Medical Center (J.L.K.), Seattle, Washington 98195-6176

Address all correspondence and requests for reprints to: Irl B. Hirsch, M.D., University of Washington Medical Center, 1959 NE Pacific Street, Box 356176, Seattle, Washington 98195-6176. E-mail: ihirsch{at}u.washington.edu.

There is increasing evidence that aggressive glycemic control for patients admitted into the hospital improves clinical outcomes, especially for patients with cardiovascular disease. There appear to be a variety of mechanisms for this. Although hyperglycemia has been shown to result in poor wound healing and more infectious complications, especially after cardiac surgical procedures, what has become clear is that the treatment of hyperglycemia with iv glucose, insulin, and potassium (GIK) results in better clinical outcomes even in patients without diabetes. The mechanisms for this are not year clear, but could be related to the insulin administration, perhaps due to suppression of various cytokines or free fatty acids. The practical use of insulin in these patients requires basic understanding of the use of both iv and sc insulin. Although there are several appropriate options for both of these routes of administration, it is critical that all caregivers involved in this population’s care are knowledgeable about insulin strategies.

Abbreviations: CABG, Coronary artery bypass grafting; CV, coefficient of variance; FFA, free fatty acid; GIK, glucose, insulin, and potassium; ICU, intensive care unit; NPO, not allowed to eat.

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